South struggling on health and welfare: the levers of industrial transition and integrative healthcare

The industrial transition identified by projects such as the Zes Unica can be a decisive lever for the Mezzogiorno, not only in terms of economic development but also insofar as it is capable of indirectly improving the population's state of health and wellbeing, inducing a greater diffusion of supplementary health welfare instruments that can reduce the renunciation of treatment for economic reasons by two percentage points. In order for this 'leap' in terms of health and socio-economic wellbeing to be possible, however, three priorities must be pursued, capable of mitigating and gradually overcoming the fragility and territorial inhomogeneity that in the South has among its most onerous consequences the phenomenon of health migration. A possible strategy is outlined by the Health Wellbeing and Resilience Observatory of the Ries Ets Foundation, in the paper 'Economic fragility, integrative welfare and the Mezzogiorno', presented in the Senate with the participation of key players in the country's economic and social scenario - from Confindustria to Federmanager to the Bank of Italy to national and international health institutions such as Oms Europa - on the initiative of Francesco Zaffini, president of the 10th Health Commission of Palazzo Madama and promoter of the integrative healthcare reform project. Which, he announced, 'should see the light by the end of the parliamentary term'.

"Our policy proposals are based on three elements,' warns the coordinator of the Ries Observatory, Duilio Carusi. 'First of all, technical and managerial training must be promoted in the South to support productive development, counteracting the dispersion of human capital towards the more developed areas of the country. At the same time, the conditions must be created to allow citizens to develop their life path close to their family unit of origin. A fundamental element,' he warns, 'to exponentially improve the health and wellbeing conditions of the elderly but also of young adults, counteracting the isolation and disintegration that also heavily condition choices in terms of birth rate'.
Third proposal, the development of integrative health welfare to support the SSN as a tool for accessibility to care. Inapp has certified this: recourse to 'funds' cuts the renunciation of care for economic reasons from 5.3% to 3.3%. This is a phenomenon that is on the increase in Italy and that most affects the South. "Three lines of action are on the horizon," Carusi explains in this regard, "linked to the promotion of solidaristic and non-profit models, so as to maximise the return in terms of services, but also to broadening the eligible audience, extending access to self-employed workers and public employees, with particular attention to the areas of southern Italy where the presence of public employment is more relevant. And finally, related to the strengthening of protections in the area of Long Term Care, not only for active workers but also for the elderly and pensioners'.

The spread of integrative welfare, however, goes hand in hand with company size and it is precisely the most disadvantaged area of the country that is characterised by an industrial fabric in which micro-enterprises prevail. The Ries Foundation paper frames a real vicious circle: the weakness of the local production system fuels employment fragility and consequently limits access to integrative welfare, contributing to the social and economic marginalisation of the most disadvantaged areas.
This is where the poverty and fragility bands are concentrated, which in Italy exceed 40% of the population as a whole, according to unpublished data presented by Andrea Brandolini, Deputy Head of the Economy and Statistics Department at the Bank of Italy. By 2022, the picture of economic fragility and poverty in Italy was made up of 3.8% of 'only poor', 17.9% of 'poor and fragile' and 22.2% of 'only fragile' - that is, people in any case at risk of slipping into the poverty-fragility mix, perhaps because of 'catastrophic' health expenditure, against 56.1% of 'neither poor nor fragile'.
In the South, the incidence of absolute poverty is 12% compared to a national average of 9.7%, and where the renunciation of care - which grew from 6.3% in 2019 to 9.9% in 2024 - has the greatest impact, mostly affecting the unemployed, precarious workers and people with low levels of education. Supplementary healthcare could lend an important hand, but it suffers from the geographical distribution of health funds whose members are concentrated in the central-northern regions according to a dynamic that goes hand in hand with that of businesses, both in terms of numbers and size. The fact that micro-enterprises prevail in the South is directly reflected in the level of welfare provided, which grows proportionally as company size increases.

Hence the importance of an experience such as the Single Economic Zones (Zes Unica), which from 2024, as the Ries Foundation points out, "constitutes a strategic opportunity for the economic revival and enhancement of Southern Italy, with an estimated economic multiplier of 2.6" and with a "territorial regeneration" fallout also on quality of life and intergenerational cohesion for that area of the country.

Certifying its advantages is Confindustria director general Maurizio Tarquini: "The Single Economic Zone with the simplification it envisages is a successful experiment and we cannot lose it: investments are the key to countering and potentially overcoming socio-economic fragilities. We have proof of this with the Zes Unica, which with an allocation of 4.8 billion in intervention allows for 35 thousand jobs and 28 billion in investment'. We need to move forward along this road'. But a wide-ranging strategy must be put in place, warns Tarquini: 'Let's make the size of companies grow, let's make those who do not pay taxes pay them, and let's put in place all the tools to face the country's challenge of growing from zero to 2 per cent. Otherwise our children will leave Italy'.